Healthcare Provider Details

I. General information

NPI: 1194554139
Provider Name (Legal Business Name): COLBY GRACE REED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 RUSSELL AVE
JEFFERSON CITY TN
37760-2204
US

IV. Provider business mailing address

PO BOX 643
CHIEFLAND FL
32644-0643
US

V. Phone/Fax

Practice location:
  • Phone: 865-471-2000
  • Fax:
Mailing address:
  • Phone: 352-507-2556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number3209
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: